Glycopeptide tolerance in bacteria causing endocarditis

Glycopeptides have been recommended as therapy for endocarditis. MICs and MBCs of vancomycin and teicoplanin were compared for 100 isolates from patients with proven bacterial endocarditis. MICs were generally lower for teicoplanin and tolerance to both agents was common. Almost all isolates of enterococci were tolerant to both glycopeptides. Among the streptococci, 78% were tolerant to teicoplanin and 57% to vancomycin. Similar findings were demonstrated for staphylococci. Although isolates appear sensitive to glycopeptides, bactericidal activity cannot always be predicted. If a glycopeptide is indicated for treatment of endocarditis, combination therapy with a suitable aminoglycoside should be considered unless MBC testing can be performed.